I find it impressive that the two of you can post back and forth all day. It's like you have nothing better to do all day....
Disappointed that you chose this tone. I usually agree with what you say. And, then you post over a 1,000 word response. Pot, meet kettle?
Don't worry about what I do with my time, and I won't worry about how you spend yours. Again, no need to be a dick. Just talk to the facts. I'm here to help. I've "been there, done that." So I have my own personal reasons for posting. I surmise the same from you. So, let's keep it civil.
My thoughts:
1. There were 26400 PGY-1 spots in the match this year. We can ignore the PGY-2 spots, since everyone who gets one of those needed a PGY-1 spot. This is an increase of about 2000 spots compared with last year, half of which were in IM.
I don't think you can completely ignore the PGY-2 spots, because those that don't go filled provide an opportunity for someone who spent a year in a prelim PGY-1 spot (or transferring from another specialty) to get a spot they otherwise wouldn't have. What I'm saying is that this still
counts as the overall increase in spots, and not just a
de facto throw-away number through which we should discount over
2,000 positions.
2. Some, if not most, of the increase in spots in the match this year were probably from the all in policy. Many programs have been all in forever. Some take everyone outside the match. Some did both -- filled half their spots outside the match, and the other half inside. This year, those programs were forced to be all in or all out. Most went all in (as they didn't want to lose the 1/2 of their residents that were AMG's in the match), so those spots that previously were pre-matches are now in the match. Hence, much of the increase in spots in the match this year do not represent the opening of new positions, but rather a shift of positions from pre-matches to matched positions.
You don't know this for a fact. Most of the high-caliber programs have
always had all of their positions in the match. Many smaller and/or community programs may not have, but again these are captured in the ACGME database.
https://www.acgme.org/ads/Public/Reports/Report/3
You can go to that link and run reports for each year. The problem is that it gives you
all residents across all specialties for all training years. So, you cannot easily derive the first-year spots. However, you can compare year-to-year the increases, and how that affects all residents across all programs.
For example, comparing 2012-2013 academic year (119,479
total positions) to the 2011-2012 academic year (115,293
total positions) already shows that, in just that one year, there was an increase in
not necessarily funded training positions of
4,186, which means that those spots are available. Those residents have to come from somewhere, don't they?
You can go to this link and compare the numbers again once the 2013-14 academic data is entered. I would suspect that you will see a similar increase.
3. The number of US grads in the match was relatively constant from 2010-2012 at 16500, give or take. This year we saw an increase to 17400. The AAMC has called upon medical schools to increase class sizes by 15%. Many schools have increased class sizes, but often by less. If we assume a 10% increase (a number I have completely fabricated based upon no data whatsoever), that would increase the 16500 --> 18100.
Reasonable estimation. Still doesn't outpace ACGME expansion.
4. There have been a few new allopathic schools that have opened. Some are in development, might fail due to budgetary issues. If we assume that at least 6 new schools open, perhaps with an average class size of 125, that would be another 750 graduating seniors, for a total of 18850.
Reasonable estimation. Still doesn't outpace ACGME expansion.
4b. After all that work, I see that the answer is readily available. This table:
https://www.aamc.org/download/321442/data/2012factstable1.pdf shows matriculants to US medical schools for 2012. Bottom of the table, you'll see 19517 new students enrolled in 2012. Few will fail out, so presumably we'll see that many graduates in 2016. A bit "worse" than my back-of-the-envelope calculations.
And, less than mine (if you see my post above). And, this presumes that all will go to the match, few will get held back, etc.
5. On the osteopathic side, there have also been class size increases and some new schools opening. AACOM's website says there were 5600 matriculants in 2011-12, and they predict 6600 matriculants by 2015. How many of these will match in the AOA match is unclear, but let's assume "worst case scenario" where there are no new AOA spots and all of the increased 1000 of them enter the NRMP match. Adding that to the 2600 DO students already participating in the match, and we have a grand total of 23100 US seniors participating in the match.
Don't forget about osteopathic-only residency programs, which currently has 2,655 spots and will also likely expand.
http://www.natmatch.com/aoairp/stats/2012prgstats.html
Those who don't make it (or want to go) in the ACGME Match will still be able to fill these programs.
6. Assuming no growth in the number of GME spots, we'd have a match with 26400 spots and 23100 US grads including DO's. This ignores the early match, and military spots. So even with all of the growth, I don't see the number of US grads exceeding GME spots. It's clearly going to get tighter and more competitive, and just being an "average" Carib grad might not yield a match.
I think it is false assumption that there will be no additional growth of first-year spots. But, I agree that they will not exceed total number of spots. And, I've never (anywhere) ever said that you don't have to be competitive. The point is if you go to a lower-tier and/or not widely recognized Carib school, all bets are certainly off in this timeframe.
7. Will GME spots grow? That's a very hard question to answer. The ACGME is not actively creating new spots. The ACGME simply accredits programs and defines their maximal size based upon educational resources. They are not trying to manage the physician supply in the US. GME funding is capped, such that most new spots that open are unfunded. Whether an unfunded spot is budget positive, negative, or neutral is a hotly debated topic, and depends heavily on assumptions made about replacement costs etc. Some hospitals have closed due to financial pressures, and that might actually decrease residency spots (although funded spots that are closed can be redistributed to programs that open new spots, so chances are every closed spot will simply reopen elsewhere)
I think I've already done an adequate job of disproving your premise here. No additional comments.
8. The "physician shortage" often mentioned is also in the eye of the beholder. We are told that there will be a physician shortage due to more people getting insurance, and baby boomers retiring and becoming ill. In the latter case, once the baby boomers die, we'll need less docs. And, whether we have a doc shortage depends on practice models (i.e. docs practicing alone vs working with a team of NP/PA's), practice sizes, specialist needs and supply, and distribution. It's really complicated, and I don't pretend to be an expert in this area. Some experts feel we have a distribution problem -- too many docs in urban / popular areas and/or too many specialists.
It's not in the "eye of the beholder". There is a shortage. Period. It's not just maldistribution. Go look at some of the COGME reports in the 1990's. These guys were idiots who should've never been given that much power. And, we're paying the price for it now. This humongous mistake has created a whole measure of regulatory problems that my field - and me personally active in it in my state - are now contending with, namely the assault of midlevels attempting to get expanded practice rights.
I assume that you and I are probably roughly the same age (me, mid-forties). The question you (and society) has to ask themselves is, when you retire and start having significant health problems, do you want the advanced training and expertise of a physician making the decisions, or that of someone who has two-years of post-college training and is essentially turned loose on the public with out the benefit of a structured post-school training program that the ACGME provides.
-Skip
Solid advice.
